Nominations to the Greater Toronto Airports Authority ...
|[pic] |Corporate Services, Clerk’s |Nominations to the Greater Toronto |
| |10 Peel Centre Dr., 5th Floor |Airports Authority (GTAA) |
| |Brampton, ON L6T 4B9 |Board of Directors |
| |905-791-7800 ext. 4330 | |
|Please Print Clearly |
|1. General |
|Applicant’s Last Name |First Name |Home Tel. No. |Bus. Tel. No. |
| |Initial | | |
| | | | |
|Street/P.O. Box No. |Apt. No. |City/Town |Province |Postal Code |
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|2. Skills and Abilities |
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|Describe specific skills including experience on boards of complex business organizations, financial literacy, or senior private or public-sector leadership and|
|accomplishments. (Attach additional pages and/or resumé if required.) |
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|3. Community Involvement |
| |Name of Agency |Telephone Number |From |To |
| | | |Yr. |Mo. |Yr. |Mo. |
|1 | | | | | | |
| |Address |Position Held |Contact Name |
| | | | |
| | | | |
| |Name of Agency |Telephone Number |From |To |
| | | |Yr. |Mo. |Yr. |Mo. |
|2 | | | | | | |
| |Address |Position Held |Contact Name |
| | | | |
| | | | |
| |Name of Agency |Telephone Number |From |To |
| | | |Yr. |Mo. |Yr. |Mo. |
|3 | | | | | | |
| |Address |Position Held |Contact Name |
| | | | |
| | | | |
| |Name of Agency |Telephone Number |From |To |
| | | |Yr. |Mo. |Yr. |Mo. |
|4 | | | | | | |
| |Address |Position Held |Contact Name |
| | | | |
| | | | |
V-02-049 03/02
|4. Other Information |
|I am a resident, owner or tenant of land in the Region of Peel or spouse of such a person. |( Yes |( No |
|I have demonstrated community involvement in the Region of Peel. |( Yes |( No |
|I have knowledge and skills related to one of the following areas: finance and human resources with regard to executive compensation, |( Yes |( No |
|executive succession planning, talent management, labour relations and creating a high performance culture. (If Yes, please specify in | | |
|Section 2.) | | |
|I have prior experience on a Board of Directors. (If Yes, please specify in Section 2.) |( Yes |( No |
| |( Yes |( No |
|I have availability during normal business hours as well as evening hours, as attendance will be required at board, committee and public | | |
|meetings. Please indicate the approximate number of hours per month you can devote to GTAA board matters. _________________ | | |
|I have specific knowledge or experience which may be an asset to the Board. (If Yes, please specify in Section 2.) |( Yes |( No |
|I am an officer or employee of a firm or corporation, including any airline or other service provider, which carries |( Yes |( No |
|on business at an airport operated by the GTAA. (If Yes, please specify in Section 2.) | | |
| |( Yes |( No |
|I am a member, officer or employee of a trade union, professional or business association which represents any firm or corporation, or the | | |
|employees of any firm or corporation, which carries on business at an airport operated by the GTAA. (If Yes, please specify in Section 2.) | | |
| | | |
|5. Mandatory Requirements |
|I certify that: |
|I am a Canadian citizen or permanent resident at least 18 years of age; |
|I am not related to another member of the GTAA Corporation; |
|I have not been found by a court to be a mentally incompetent person of unsound mind; |
|I am not an undischarged bankrupt; |
|I have not been convicted of an indictable offence; |
|Currently and within the past two years, I do not and have not held federal, provincial, or municipal elected office, nor am I or have I been a member of the |
|Senate; |
|Currently and within the past two years, I am not or have not been an employee or agent of Her Majesty the Queen in Right of Canada or a province, or an employee or|
|agent of a crown corporation, an officer or employee of a municipality, officer or employee of the GTAA, a shareholder or subsidiary of the GTAA, or filed a return |
|under the Lobbyists Registration Act or registered under a similar provincial or municipal law; |
|I am not a director, officer, or employee of any person who has, or within six months immediately preceding the date of appointment had, a financial or commercial |
|agreement or arrangement with the GTAA, the Government of Canada or the Ontario Government, The Regional Municipalities of Peel, York, Halton or Durham or the City |
|of Toronto that could reasonably be perceived to interfere with their ability to discharge their fiduciary duty to act honestly and in good faith in the best |
|interests of the GTAA. |
|6. Declaration |
| |
|I hereby certify the statements made herein are true and I understand that any falsification of facts submitted in this form is cause for discharge from the Region |
|of Peel nomination process to the Greater Toronto Airports Authority (GTAA) Board of Directors. |
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|Signature of Applicant | |Date | | | | |
| | | |Yr. |Mo. |Day | |
Deadline for Submission
Friday, May 18, 2018 - 4:30 p.m.
Please fax completed applications to the attention of the Regional Clerk at 905-791-1693 or personal delivery to 10 Peel Centre Dr., Brampton – 5th Floor, Office of the Regional Clerk
|Notice With Respect To The Collection of Personal Information |
|(Municipal Freedom of Information and Protection of Privacy Act) |
|Information on this form is collected for the administration of the Greater Toronto Airports Authority (GTAA) Operating By-law 14, sections 4.3 and 4.4 (b) to |
|determine suitability for appointment to the GTAA Board of Directors. Questions about this collection of personal information should be forwarded to the Regional |
|Clerk, 10 Peel Centre Dr., Brampton, ON L6T 4B9, 905-791-7800, Ext. 4330 |
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